title: National Institutes of Health classification for chronic graft-versus-host disease predicts outcome of allo-hematopoietic stem cell transplant after fludarabine-busulfan-antithymocyte globulin conditioning regimen.
abstract: Abstract In 2005, the National Institutes of Health (NIH) proposed standard criteria for diagnosis, organ scoring and global assessment of chronic graft-versus-host disease (cGvHD) severity. We retrospectively reclassified cGvHD with NIH criteria in a monocentric cohort of 130 consecutive adult patients with hematological malignancies presenting cGvHD after receiving allo-hematopoietic stem cell transplant (HSCT) with a fludarabine-busulfan-antithymocyte globulin (ATG) conditioning regimen, among 313 consecutive HSCT recipients. We compared NIH and Seattle classifications to correlate severity and outcome. The follow up range was effectively 2-120 months. Forty-four percent developed Seattle-defined cGvHD (22% limited, 78% extensive forms). Using NIH criteria, there were 23%, 40% and 37% mild, moderate and severe forms, respectively, and 58%, 32% and 8% classic cGvHD, late acute GvHD and overlap syndrome. Five-year overall survival was 55% (49-61), and cumulative incidences of non-relapse mortality (NRM) and relapse/progression at 2 years were 19% (14-23) and 19% (14-24). NIH mild and moderate forms were associated with better survival compared to severe cGvHD (hazard ratio [HR] = 3.28, 95% confidence interval [CI]: 1.38-7.82, p = 0.007), due to higher NRM among patients with severe cGvHD (HR = 3.04, 95% CI: 1.05-8.78, p = 0.04) but comparable relapse risk (p = NS). In conclusion, the NIH classification appears to be more accurate in predicting outcome mostly by the reclassification of old-defined extensive forms into NIH-defined moderate or severe.
authors.affiliation: Hematology Department, Institut Paoli-Calmettes , Marseille , France.
authors.forename: Colombe
authors.initials: C
authors.lastname: Saillard
authors.forename: Roberto
authors.initials: R
authors.lastname: Crocchiolo
authors.forename: Sabine
authors.initials: S
authors.lastname: Furst
authors.forename: Jean
authors.initials: J
authors.lastname: El-Cheikh
authors.forename: Luca
authors.initials: L
authors.lastname: Castagna
authors.forename: Alessio
authors.initials: A
authors.lastname: Signori
authors.forename: Claire
authors.initials: C
authors.lastname: Oudin
authors.forename: Catherine
authors.initials: C
authors.lastname: Faucher
authors.forename: Claude
authors.initials: C
authors.lastname: Lemarie
authors.forename: Christian
authors.initials: C
authors.lastname: Chabannon
authors.forename: Angela
authors.initials: A
authors.lastname: Granata
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002066:Busulfan / Q000008:administration & dosage; D018890:Chemoprevention; D002908:Chronic Disease; D018450:Disease Progression; D006086:Graft vs Host Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D012720:Severity of Illness Index; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine